Provider Demographics
NPI:1457359200
Name:KISMET SUX LLC
Entity Type:Organization
Organization Name:KISMET SUX LLC
Other - Org Name:EMBASSY REHAB AND CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-642-7736
Mailing Address - Street 1:600 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:ELK POINT
Mailing Address - State:SD
Mailing Address - Zip Code:57025-2144
Mailing Address - Country:US
Mailing Address - Phone:605-356-2622
Mailing Address - Fax:605-356-2704
Practice Address - Street 1:206 PORT NEAL RD
Practice Address - Street 2:
Practice Address - City:SERGEANT BLUFF
Practice Address - State:IA
Practice Address - Zip Code:51054-8098
Practice Address - Country:US
Practice Address - Phone:712-943-3837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA970471314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1457359200Medicaid
IA165145Medicare Oscar/Certification